Comparison of Frequency of Referral to Cardiothoracic Surgery for Aortic Valve Disease in Blacks, Hispanics, and Whites

Racial differences in prevalence and in intervention rate of those with severe aortic stenosis have been reported. Our objective was to evaluate health disparities in referral to cardiothoracic surgery (CTS) for aortic stenosis in black and Hispanic compared with white patients before the transcatheter aortic valve replacement program was started in our community. Using a retrospective cohort design, we identified all patients >40 years, who had been captured with aortic valve disease from January 2011 to June 2016. Clinical and echocardiographic data were collected manually. Exposure was race/ethnicity; outcome was referral to CTS. Multivariable logistic regression analysis was conducted with variables that had significance of p <0.20 in univariate model. We included 952 patients in the final analysis (423 white, 376 black, and 153 Hispanic). Compared with whites, black subjects were significantly younger, had more advanced degrees of kidney disease, were more likely to have Medicaid as payer, and had more atherogenic co-morbidities. Black patients had significantly higher aortic valve area indexed for body surface area, more aortic regurgitation, lower peak velocities, lower transvalvular gradients, less calcified valves, and fewer patients in aortic stenosis stage D. The adjusted odds ratio for CTS referral was 0.48 for blacks (p <0.001) and 0.86 for Hispanics (p = 0.73) compared with whites. In conclusion, after adjusting for clinical and echocardiographic variables, black patients were less likely to be referred to CTS for treatment of aortic valve disease. We found no difference in the referral pattern of Hispanic compared with white patients.